Archer medicine question 162 - opthal - misshyd

[ArchivalUser]

A 35 Year old woman presents for evaluation of recurrent headaches for the past few months. Lately, she has been waking up with a headache almost daily though it tends to improve in the latter half of the day. She is frustrated as she can not even get some sleep during the attack since lying down makes her feel worse . She has associated nausea. She has transient attacks of light flashes that resolve spontaneously. Her menstrual history is unremarkable. On physical examination, she has no neurological deficits. Funduscopic examination shown below:
http://usmlegalaxy.files.wordpress.com/2...ic-001.jpg

Which of the following information, if elicited in the patient history, would increase the clinical suspicion of the diagnosis?
A) Constipation
B) Family History
C) Recent weight gain
D) Galactorrhea
E) Urinary incontinence

[ArchivalUser]

Papilloedema, nausea, headache, light flashes, no mass effect

Look like idiopathic .

Headache wake her up...can be brain tumor, but not likely as sym last for few mo, no other clues.

After exclusion , is it C?

[ArchivalUser]

I think its C too

[ArchivalUser]

ok this is papilloedema and classic symptoms of high ICP.
now,
A.headache with constipation? there is no correlation between this two symptoms
B.Migraine doesn't give you papilloedema
D.in female prolactinome that gives galactorrhea is most commonly microadenoma that can't give mass effect.
E.for NPH traid is dementia, urinary incontinence and gait problem. There is no headache in there.

So, only thing that remains is C.(Idiopathic)

[ArchivalUser]

It's pseudotumor cereberi aka intracranial hypertension caused by caused by either ocp, isotretinoin,tetracycline or in some cases idiopathic as in this case most likely.it is xterized by headache ,papilloedema ,weight gain


C of course

[ArchivalUser]

CC........

[ArchivalUser]

headache in the morning that improve towards the end of the day, papilledema are important clues to Pseudotumor cerebrii. Another imp clue is headache worsening with lying down which occurs in this condition due to further raised intracranial tension on lying down
Recent weightgain is a great piece in the history to support the diagnosis